<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Rebate_recover_msg')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-rebate_recover_msg" class="form-control" name="row[rebate_recover_msg]" data-rule="required" type="text" value="{$row.rebate_recover_msg}">
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Rebate_recover_money')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-reason" class="form-control" name="row[rebate_recover_money]" data-rule="required" type="text" value="{$row.rebate_recover_money}">
        </div>
    </div>
    {if $row.recover_status == 1}
        <div class="form-group layer-footer">
            <label class="control-label col-xs-12 col-sm-2"></label>
            <div class="col-xs-12 col-sm-8">
                <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            </div>
        </div>
    {/if}
</form>
